§18082 Advance determination and payment of premium tax credits and cost-sharing reductions

Summary

The federal health department, working with the Treasury, must set up a program that lets a health Insurance Exchange ask for advance checks to see if someone can get premium tax credits and cost‑sharing reductions when they enroll in a plan. The department must tell the Exchange and the Treasury about those advance decisions. If employees qualify because their employer did not offer coverage, or offered coverage that was unaffordable or did not meet minimum value, the department must tell the Treasury the employer’s name and employer ID number. The Treasury must send the advance tax credits to the insurance companies so people pay lower monthly premiums. Advance eligibility checks must usually happen during the person’s open enrollment (or another enrollment period the department allows) and use the most recent tax‑year income information the department can get. The program must also let people use newer or estimated income when things change a lot, for example a 20% or larger drop in income, a new unemployment claim, a change in family size, or other big life changes. Insurers that get advance payments must cut the person’s premium by that amount, tell the Exchange and the department, show the reduction on bills, and allow a three‑month grace period for missed payments before ending coverage. Federal money, credits, or reductions cannot be given to people who are not lawfully in the United States. States may still make extra payments to help people buy plans on top of the federal help.